The syllabus was recently released for the International Seating Symposium held last month in Vancouver. One of the more interesting talks that caught our eye was the use of gaming technology to enhance wheelchair skills presented by Ed Giesbrecht.
There have been numerous attempts for commercial game consoles to develop wheelchair specific applications for leisure. As well as this, gamification (applying gaming elements to skills training) is becoming a popular way to make rehabilitation more engaging and it allows for graded progression of skill acquisition. Unfortunately, developing motor skills required for wheelchair mobility often requires repetition and refinement. So the benefits of using gaming technology include reducing the tedium in repetitive skills training and maintaining motivation for learners who may not sense progress in their skills otherwise.
The Heureka Museum in Finland has an interactive wheelchair exhibit that teaches basic skills. A manual wheelchair sits on a circular platform with quadrants, which light up randomly, one at a time. You have to roll at least two wheels over the quadrant before the next lights up. Music plays and if you take too long the music begins to slow down providing feedback to the user. Check it out here…
“Virtual Reality” technologies attempt to simulate or replicate diverse activities within a restricted environment. For example, adaptation of commercial products, such as the Nintendo WiiTM and Microsoft KinectTM, use input from an external device (controller) mounted to the wheelchair or recognition of specific wheelchair and body movements.
Gerling et al have developed a program for Microsoft KinectTM called KINECTWHEELS, that provides motion-based games activated by various wheelchair movements: forward, backward, left and right. The system does not discriminate the distance, speed or angular movement of the wheelchair and consequently they operate like four directions on a joystick or arrow keys on a keyboard. As a result, the system provides access to motion-based games for wheelchair users but does not allow for practice of precision wheelchair movements required for specific mobility skills training.
To see KINECTWHEELS in action click here.
Astrowheelie has been developed for use with Nintendo WiiTM for manual wheelchair users. Two Wii controllers are mounted to the spokes of the wheelchair so that joystick/keyboard functions are replicated by wheeling in a particular direction when playing a game such as Asteroids. The system incorporates a laptop computer mounted on the user’s lap. The main goal is provide exercise like the Kinect rather than to practice specific mobility skills.
GAME(Wheels) is an innovation developed at the University of Pittsburgh. It involves a roller platform that incorporates a custom video game to train wheelchair propulsion. Once the wheelchair is mounted in the structure, propelling the drive wheels emulates joystick movement, with faster speed indicating forward movement and turning indicating left and right movement. Customized games and training information are displayed on a PC monitor mounted in front of the user. While the system has shown promise for improving propulsion technique and achieving a beneficial exercise effect, it requires a fairly elaborate structure to suspend the drive wheels and it does not currently address a wider variety of mobility skills beyond forward propulsion. This product is not yet commercially available.
Further information on GAME(Wheels) can be found here.
More recently, a computer tablet-based training program (EPIC Wheels) was developed for older adults incorporating video-based games that require performance of specific wheelchair skills. In addition to instructional videos, the program integrates training activities and games to encourage practice and embed motor learning. The user watches the video animation on the tablet screen and responds by performing specific skills or manoeuvres. Preliminary analysis from an ongoing randomized control trial suggests these video-based games are a popular program element among trainees.
These games offer several potential advantages:
They are relatively easy to create and configure
The increasing complexity of the game can be a motivator to persevere with practice
The novelty of animation may peek interest among users
The tablet-based gaming format allows trainees to play games without the need for a playing partner
One limitation is the lack of interaction between player and game. While the user moves their chair in response to the video stimulus, their performance does not directly impact game action. For example, the Elevator game requires the user to enter and exit a virtual elevator on the tablet screen before the elevator doors close; however, the game continues regardless of whether the user is successful or not. The capacity to provide performance feedback has been identified as important to game-related rehabilitation and is a goal for further development of this intervention.
Listen to what Ed Giesbrecht has to say about the technology of EPIC Wheels as well as see it in action here. Or read more about EPIC Wheels here.
In response to the current game limitations, Ed says his team is currently exploring the use of low-cost external sensors mounted on the wheelchair’s drive wheels to create a more interactive gaming experience called WheelTime. The Bluetooth-enabled sensors measure the relative orientation of the wheels and wheel travel, tracking movement and position. This provides several advantages over the gaming console devices:
The sensors can track any movement in the x-y plane (forward, backward, turns, spins, etc.) and determine angular changes (i.e. partial versus full turns).
The player does not need to remain within a small viewing range, as with the Nintendo KinectTM. The “occupied space” for the games can be customized within the software to fit to the room the user is in.
Types of Games
Two types of games are currently being considered for the technology above: immersive and task-based. The immersive game provides relative freedom of movement and allows the user to pursue a goal and receive feedback on their achievementsThe task-based game is more prescriptive, requiring the player to perform a specific manoeuvre and providing feedback on their performance. The games have several “skill settings” which allow for more challenging tasks, increasing complexity and greater performance precision demands. Ed’s team is currently testing the sensor-based video games with groups of older adults to explore acceptability and user perceptions of wheelchair-controlled gaming activities. This feedback will inform the next iteration of sensor-based games and help set direction for further study.
The content of this article is edited from Ed Giesbrecht’s talk and abstract from the 32nd International Seating Symposium.
Report by Nicola Falconer A recent study has found the presence of chronic lower limb oedema (CLLO) in multiple sclerosis patients (MS) to be 62%